After Wisdom Tooth Removal

The removal of impacted teeth is a serious surgical procedure. Post-operative care is very important. Unnecessary pain and the complications of infection and swelling can be minimized if the instructions are followed carefully.

Immediately Following Surgery

The gauze pad placed over the surgical area should be kept in place for an hour. After this time, the gauze pad should be removed and discarded.

Vigorous mouth rinsing, or touching the wound area, following surgery should be avoided. This may initiate bleeding by causing the blood clot that has formed to become dislodged.

Take the prescribed pain medication(s) as soon as it is filled at the pharmacy and before you begin to feel discomfort. This will usually coincide with the local anesthetic becoming diminished.

Restrict your activities the day of surgery and resume normal activity when you feel comfortable, approximately 3 days.

Place ice packs to the sides of your face where surgery was performed. Refer to the section on swelling for explanation.

At Home

As soon as you get home, either lie down with a pillow supporting your head or recline in a comfortable chair or sofa. Rest until the effects of anesthesia have worn off. Do not stand up quickly or try to be active. If you feel faint or dizzy, lie down with your feet elevated until the feeling passes. An responsible adult should stay with the you until the effects of anesthesia have completely worn off.

Bleeding

A certain amount of bleeding is to be expected following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon and may last 2 to 3 days following surgery. Excessive bleeding may be controlled by first rinsing or wiping any old clots from your mouth, then placing a gauze pad over the area and biting firmly for thirty minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.

Swelling

The swelling that is normally expected is usually proportional to the surgery involved. Swelling around the mouth, cheeks, eyes and sides of the face is not uncommon. This is the body’s normal reaction to surgery and eventual repair. The swelling will not become apparent until the day following surgery and will not reach its maximum until 2-3 days post-operatively. However, the swelling may be minimized by the immediate use of ice packs. Two baggies filled with ice, or ice packs, should be applied to the sides of the face where surgery was performed. The ice packs should be left on continuously while you are awake. After 36 hours, ice has no beneficial effect and can actually prolong the effects of swelling. If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. Thirty-six to forty-eight hours following surgery, the application of moist heat to the sides of the face is beneficial in reducing the size of the swelling.

Pain

For moderate pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours or Ibuprofen, (Motrin or Advil) two-four 200 mg tablets may be taken every 3-4 hours. A combination of 1 extra-strength (500 mg) Tylenol and 1 regular (200 mg) Ibuprofen taken every 4 – 6 hours is noted to be effective in relieving pain than taking more pills of a single drug.

For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and will slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. Pain or discomfort following surgery should subside more and more every day. If pain persists, it may require attention and you should call the office.

Taking medications more than prescribed may lead to unexpected medical complications and emergencies: Please follow all directions for medication usage. You should also remember that painmedications are intended to help make you feel better but are not intended to make you pain free.

Diet

After general anesthetic or I.V. sedation, liquids should be initially taken. Drink from a glass or use a straw for thin liquids (such as water or Gatorade). The sucking motion of a straw can cause more bleeding by dislodging the blood clot if used to consume thicker liquids (such as a milkshake). You may eat anything soft by chewing away from the surgical sites. High calorie, high protein intake is very important. Nourishment should be taken regularly. You should prevent dehydration by taking fluids regularly. Your food intake will be limited for the first few days. You should compensate for this by increasing your fluid intake. At least 5-6 glasses of liquid should be taken daily. Try not to miss a single meal. You will feel better, have more strength, less discomfort and heal faster if you continue to eat. Caution: If you suddenly sit up or stand from a lying position you may become dizzy. If you are lying down following surgery, make sure you sit for one minute before standing.

Keep the mouth clean

Gentle rinsing may be started the evening of your surgery. You can brush your teeth gently/lightly the following morning or afternoon. The day after surgery, you should begin gentle rinsing several times a day, especially after eating, with a cup of warm water (mixed with a teaspoon of salt if desired). Mouth rinses with alcohol should be avoided.

Discoloration

In some cases, discoloration of the skin follows swelling. The development of black, blue, green, or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur 2-3 days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.

Antibiotics

If you have been placed on antibiotics, take the tablets or liquid as directed. Antibiotics will be given to help prevent infection. Discontinue antibiotic use in the event of a rash or other unfavorable reaction and phone the office to alert us of this.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on coke, tea or ginger ale. You should sip slowly over a 15 minute period. When the nausea subsides you can begin taking solid foods and the prescribed medicine. Phone the office if this happens several times.

Other POSSIBLE Complications

If numbness of the lip, chin, or tongue occurs there is no cause for alarm. As stated before surgery, this is usually temporary in nature. You should be aware that if your lip or tongue is numb, you could bite it and not feel the sensation. So be careful. Call our office if you have any questions.

Slight elevation of temperature immediately following surgery is not uncommon. If the temperature persists, notify the office. Tylenol or ibuprofen should be taken to reduce the fever.

You should be careful going from a lying down position to a standing one. Taking pain medications can make you dizzy. You could get light headed when you stand up suddenly. Before standing up, you should sit for one minute then get up.

Occasionally, patients may feel hard projections in the mouth with their tongue. They are not roots, they are the bony walls which supported the tooth. These projections usually smooth out spontaneously. If not, they can be removed by Drs. Heldridge, Sato or O’Neil.

If the corners of your mouth are stretched, they may dry out and crack. Your lips should be kept moist with an ointment such as vaseline.

Sore throats and pain when swallowing are not uncommon. The muscles get swollen. The normal act of swallowing can then become painful. This will subside in 2-3 days.

Stiffness (Trismus) of the jaw muscles may cause difficulty in opening your mouth for a few days following surgery. This is a normal post-operative event which will resolve in time.

Finally

Sutures are placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged, this is no cause for alarm. Just remove the suture form your mouth and discard it. Any remaining sutures will be removed approximately one week after surgery. The removal of sutures requires no anesthesia or needles. It takes only a minute or so, and there is typically no discomfort associated with this procedure.

The pain and swelling should subside more and more each day following surgery. If your post-operative pain or swelling worsens or unusual symptoms occur, do not hesitate to call our office.

There will be a “hole” where the tooth was removed. This cavity will gradually fill in with new tissue over the next several weeks. In the mean time, the area should be kept clean especially after meals with salt water rinses or a toothbrush.

A dry socket is when the blood clot gets dissolves prematurely from the tooth socket. Symptoms of pain at the surgical site and even pain to the ear may occur 2-3 days following surgery. This may be accompanied by a bad taste and/or bad breath. This is not an infection. Call our office if should you have any such symptoms .

If you are involved in regular exercise, be aware that your normal nourishment intake is reduced. Exercise may weaken you. If you get light headed, stop exercising.

Your case is individual; no two surgeries are alike. Do not accept well intended advice from friends. Do not search the internet for answers. Discuss your concerns with the persons best able to effectively help you: Drs. Heldridge, Sato and O’Neil or your family dentist.